Hypertension, Myocardial Infarction, Stroke
Conditions
Keywords
stroke, myocardial infarction, hypertension, self-management, chronic disease
Brief summary
BP-REACH is a study of a team-based (pharmacist and health coach) program for lowering blood pressure for people with a prior stroke or heart attack in the Los Angeles Department of Health Services healthcare system. The goal of this clinical trial is to test if this team based program is better at helping people reduce their blood pressure than usual care for people with prior heart attack or stroke. The main questions it aims to answer are: * Do people in the REACH BP program have lower blood pressure at 12 months compared to those getting usual care? * Do people in the REACH BP program have better Life's Essential 8 scores and patient experience compared to those getting usual care?
Detailed description
Hypertension is the leading contributor to preventable death and a major risk factor for recurrent cardiovascular events. To enhance BP control after stroke or myocardial infarction (MI), multilevel interventions are needed that incorporate health system and patient level factors. BP-REACH aims to test the impact of an intervention on systolic blood pressure (SBP) for individuals with a history of stroke or MI in a randomized controlled trial in the Los Angeles Department of Health Services healthcare system. The primary outcome will be change in systolic blood pressure (SBP) at 12 months. Hypothesis: Patients randomized to the intervention will achieve \>2.4 mm Hg greater reduction in SBP at 1 year versus those randomized to usual care. The study population will include participants from the inpatient and outpatient settings in Los Angeles County Department of Health Services health centers. The participants will be randomized in a 1:1 fashion to usual care or intervention, stratified by site, language and cardiovascular event (myocardial infarction, stroke). Outcomes will be collected from all participants at Baseline, 3 month and 12 month timepoints. The primary outcome is SBP. Participants randomized to the intervention arm will receive additional a home blood pressure monitor, monthly phone calls from a health coach, and medication initiation and titration by a clinical pharmacist. The pharmacist will follow Los Angeles County Department of Health Services expected practices, which align with the ACC/AHA guidelines for blood pressure control and AHA guidelines for Secondary Stroke Prevention.
Interventions
BEHAVIORALBP REACH Intervention
Educational materials, written and digital. Home blood pressure monitor and self management education from BP REACH coach. Monthly coaching calls from BP REACH coach. Medication management by pharmacist
Sponsors
University of Southern California
University of California, Los Angeles
University of California, Irvine
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
35 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients of LA General Medical Center, Rancho Los Amigos, Olive Medical Center or Harbor-UCLA Medical Center with ischemic stroke, hemorrhagic stroke, or myocardial infarction * English or Spanish speaking * Systolic blood pressure (SBP) ≥ 130 mm Hg
Exclusion criteria
* Age \< 35 years * SBP \< 130 mm Hg * Only speaks a language other than English or Spanish * Cannot provide informed consent due to dementia or aphasia
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Systolic blood pressure (SBP) mmHG | 12 months | Collected by study staff using blood pressure monitor |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Life's Essential 8 | 12 months | American Heart Association - survey measure. Score of 0-100, with 100 indicating a perfect score for cardiovascular health |
| BMI (body mass index) | 12 months | Height (cm) and weight (kg) collected by study staff, height divided by height indicating percentage of fat on the body |
| Total cholesterol | 12 months | Lab collection by study staff |
| HgbA1c (hemoglobin A1C) | 12 months | Lab collection by study staff |
| Diet | 12 months | Survey - California Health Interview Survey |
| Physical activities | 12 months | Survey - Behavioral Risk Factor Surveillance System Survey Questionnaire |
| Smoking | 12 months | Survey - PATH wave 1 survey |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORAlejandra Casillas, MD
University of California, Los Angeles
PRINCIPAL_INVESTIGATORAmytis Towfighi, MD
University of Southern California
Outcome results
None listed